Midwives: delivering health, saving lives

I am currently in South Africa attending the International Confederation of Midwives (ICM) Triennial Congress.  Not only is it a huge gathering of midwives from across the world, it’s celebrating some exciting firsts. It’s the first time the congress has been held in Africa, and the first publication of a report on the State of the Worlds’ Midwifery.

The report is a global assessment of midwifery and provides assessments of 58 countries where maternal and newborn mortality are high. It highlights the deficit in both numbers and competencies of the midwifery workforce.

LiST software, a computer-based tool which allows people to set up and run multiple scenarios to decide on health system interventions, was used in this case to model how many deaths could be averted if midwives attended births. It estimated that if all women in the 58 countries gave birth with a midwife in attendance in a facility able to provide basic emergency obstetric and newborn care and had access to the full range of midwifery care, there would be 61% reduction in maternal death, a 43 % reduction in foetal death and a 60% reduction in newborn death.

This equates to an estimated 3.6 million lives saved in 2015 alone.

Midwives: an investment for a better future

Midives are essential. Their skills protect women and babies at a highly vulnerable time. An investment in midwives is an investment in the health of women and newborns;  it’s an investment for a better future.

Key recommendations

The report makes solid recommendations for governments, regulatory bodies, professional associations, training institutions and international organisations and is invaluable reading for anyone with an interest in midwifery, maternal and newborn health.

The report urges governments to recognise midwifery as a distinct profession. This allows midwives to concentrate on midwifery and protects them from being pulled to carrying out other tasks in the health system. This is something I have blogged about in the past.

It also urges governments to include midwifery and midwives as human resources in costed health plans. Senior midwifery positions should be created at national level and midwives should have an input into all relevant national decisions.

Regulatory bodies are vital. They are encouraged to licence and relicense midwives and ensure scope, standards and ethics of midwifery practice. This is no small task and they will require support.

Recommendations related to schools and training institutions include:

• using ICM educational standards to improve quality and capacity of midwifery training and
• developing partnerships with maternity units in communities and hospitals for practical training.

Professional associations are encouraged to advocate and lobby for better working conditions for midwives, to promote standards for in-service training and collaborate with the associations of other health care professionals in order to strengthen input into health plans and policy development.

In order to fulfil their role, midwifery associations will need support, as in many countries they are fragile, under-resourced and face many challenges.

On a visit to Liberia last week I met a midwife who is a member of the Liberian midwives association. She said that while all midwives in Liberia gain membership upon qualification, the majority didn’t or were unable to attend meetings. She passionately encouraged her fellow midwives to actively participate in the association, so that midwives could be heard.

The report also recommends that international organisations support, monitor and encourage the scale-up and quality of midwifery services and midwifery associations and that they facilitate the international exchange of knowledge, practice and innovation.

The State of the Worlds Midwifery is a logical, well-written report with practical recommendations. And it is much -needed given that the last ever global report on midwifery was written in 1976 — 35 years ago.

However currently it’s only a report and will bring no change unless it’s used. We all need to act on its recommendations. If we are successful there is so much to gain — an estimated 3.6 million lives could be saved in 2015 alone.